Puberty (cont.)

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are medical conditions associated with early or late puberty?

Precocious puberty

Precocious puberty is the medical term for puberty that occurs earlier than usual. While medical professionals are not in full agreement about the age ranges for the definition of precocious puberty, many doctors believe that a medical evaluation for precocious puberty should be performed if breast or pubic hair development occurs prior to age 7 in Caucasian girls and prior to age 6 in African-American girls. Boys who show signs of developing secondary sex characteristics prior to age 9 are also considered to have precocious puberty. Precocious puberty can be associated with psychological difficulties that may impact a child's emotional development.

Precocious puberty is much more common in girls than in boys. Many girls experience precocious puberty in the absence of any disease or condition. In boys, however, precocious puberty is more likely to be associated with an underlying medical problem. While in many cases the exact cause of precocious puberty cannot be determined, a small number of cases are related to abnormalities of the ovaries or testes, thyroid gland abnormalities or other hormone problems, genetic conditions, tumors or infections of the brain, and injury to the brain.

Precocious puberty may be treated by treating the underlying condition that is responsible for the condition, or by lowering the high levels of sex hormones with medications (known as GnRH agonists) that block the production of sex hormones to stop sexual development from progressing.

Delayed puberty

Delayed puberty is the late onset of puberty. Puberty is usually considered to be delayed when there has been no increase in testicular volume by 14 years of age in boys and no breast development by 13 and a half years of age in girls. Sometimes, delayed puberty tends to "run in families," and normal adolescent development proceeds normally after the delay. This is sometimes called a constitutional delay and is responsible for the vast majority of cases of delayed puberty. Constitutional delay that affects both growth and achievement of puberty is much more common in boys than in girls.

Chronic medical conditions, such as diabetes or cystic fibrosis, may also cause the delayed onset of puberty. Genetic conditions, problems with the pituitary or thyroid glands, problems with the ovaries or testes, and malnutrition are other causes of delayed puberty. Many girls who exercise strenuously have very little body fat and also experience a delay in the onset of puberty, since a certain amount of body fat appears to be required for the initiation of puberty. Girls who are competitive athletes may have a delay in the onset of menstruation of up to one year or more when compared with nonathletes.

REFERENCES:

American Academy of Pediatrics. <http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/default.aspx>.